Digital Transformation in Nursing Education: The Introduction of a Clinical Practice Support System

Setnan University Website

　Prompted by the spread of COVID-19, online classes have been promoted in educational settings, and learning environments that utilize cloud services and allow students to study from anywhere have become widespread. At the School of Nursing, Setsunan University, we have been introducing electronic textbooks and digitizing clinical practice records in line with the university-wide policy of promoting Bring Your Own Device (BYOD).BYOD, where students bring their own devices to study, not only creates an environment where students can “learn anytime, anywhere” but also helps cultivate the ICT skills required in future healthcare settings.
The introduction of a clinical practice support system that manages practice records in the cloud enables faculty and clinical instructors to provide timely guidance and advice to students, which is expected to improve learning outcomes during clinical practice.Furthermore, by centrally managing clinical records (such as the creation of clinical logs and the progression of the nursing process) within the system and accumulating them as a learning portfolio throughout the student’s academic career, reflection becomes easier, leading to the delivery of education with continuity and consistency.

1. Background Leading to the System Implementation and Preparations Prior to Implementation

　
　Historically, from the perspective of personal information protection, our university had no choice but to collect records detailing students’ learning experiences upon completion of their clinical placements, which meant students were unable to accumulate these valuable learning records themselves. We believed this could be a significant setback for the development of students’ nursing practice skills. Furthermore, even when paper-based record books were kept under strict security, it was difficult to completely eliminate the risk of personal information leaks due to loss or other incidents, and management could not be considered adequate.While the School of Pharmacy was aware that the shift to cloud-based clinical records was gaining traction, we recognized that a similar approach would be difficult to implement because the content of records for pharmacy students and nursing students is entirely different. Against this backdrop, and in light of the acceleration of digital transformation (DX) across society due to the spread of COVID-19, we decided to conduct a full-scale feasibility study on the transition to cloud-based clinical records.

2. The Process Leading Up to Full Implementation

　
　Prior to implementation, all faculty members attended multiple briefings conducted by a company with a proven track record of providing practical training record and management systems to pharmacy universities nationwide. During the early stages of these briefings, many faculty members expressed concerns, citing their heavy reliance on traditional paper-based records and asking questions such as, “What are the benefits of moving to the cloud?” “Is personal information sufficiently protected?” and “Will students and instructors be able to use it effectively?”However, as the briefing sessions continued, individual faculty members gradually began to recognize the benefits, and the discussion shifted from the feasibility of implementation to practical operational details, such as “Can the system accommodate different record formats for each specialized field?”, “Can it support the creation of relationship diagrams?”, and “Can a field be provided for faculty comments?” The provider created a Teams channel for each practical training course, and faculty members posted specific requests and feedback, allowing for ongoing customization.
　We implemented the system in small steps, starting by using it for a portion of the clinical records from the first-year basic nursing practicum, and gradually expanding its use—for example, by applying it to nursing case studies during on-campus exercises in the first semester of the third year. At the same time, we introduced electronic textbooks and converted handouts into PDFs, which allowed students to bring their devices to clinical sites and look up information during their rotations, thereby improving convenience. Prior to the clinical rotations, we held workshops where students participated in discussions to exchange opinions.
　Furthermore, since a stable network connection is essential for digitizing records, we began explaining the system’s overview to our affiliated hospitals two years prior to implementation and obtained permission for the use of the hospital’s Wi-Fi or for bringing in personal Wi-Fi routers.

3. Benefits of Implementing a Field Training System

 
　We held a faculty development (FD) workshop, including student stakeholders, to evaluate the system that was recently fully implemented for clinical training. We shared information on the current usage of the electronic textbooks and the electronic clinical record system, and discussed current challenges and potential improvements with the students.While the initially anticipated benefits included improved learning outcomes through the accumulation of learning materials and a reduction in lost or misplaced records, participating students reported that “the time required for documentation has decreased dramatically.” For nursing students, documentation is a means of developing critical thinking skills
While record-keeping is essential for improvement, it had also been a factor in reducing sleep time. The time freed up by shortening the time spent on record-keeping can be devoted to reflection, which can offer significant educational benefits. Through discussions where teachers shared feedback such as, “We found the approaches and implementation methods in other subject areas helpful,” they gained various insights.
　Furthermore, we have begun to see situations where instructors provide comments on students’ records. This system is available not only to students and faculty but also to pre-registered practicum supervisors. With traditional paper-based systems, access during practicum hours was limited, making it difficult for supervisors to secure sufficient time for thorough review. However, with the transition to a cloud-based system, faculty and supervisors can now check and comment on students’ learning progress and content “anytime, anywhere.” We believe this provides a significant benefit to students by enabling them to receive practical guidance.In addition, we have received feedback from faculty members stating that the records are “easy to read,” the “amount of text in the records has increased,” it is “easier to identify omissions or errors,” there has been a “reduction in costs associated with creating practicum guidelines and record forms,” and the “burden of preparing and distributing paper materials has been reduced.”
　This also helps improve students’ ICT literacy. In the past, many students relied entirely on their smartphones for tasks such as writing reports and searching for materials; as a result, some entered the workforce without sufficient familiarity with computers and struggled with entering data into electronic medical records. The digitization of clinical practice records is also viewed as a learning opportunity that prepares students for the practical aspects of record-keeping in clinical settings.

4. Challenges in Using This System

 
　At the same time, challenges associated with digitization and cloud-based systems have also come to light. On the hardware side, depending on the communication environment at the training site, it may not be possible to enter data during training sessions. Additionally, fees for renting Wi-Fi routers and system usage fees are required. On the other hand, costs for printing training guidelines and record sheets are no longer necessary.
　The biggest challenge is that information found online can be easily copied into reports. The core of clinical practice lies in assessing patients from multiple perspectives, identifying nursing issues, and developing and implementing care plans. However, an environment where students can easily copy and paste descriptions found online or content generated by AI without sufficient scrutiny hinders their thought processes and could ultimately lead to a decline in the quality of nursing care.
　However, today’s digital transformation is expected to create new value and continue to evolve in the future. That is precisely why we must accurately understand its limitations and risks, and cultivate the ability to utilize it effectively in learning. To nurture students who can use ICT not merely to “find answers,” but as a “tool to deepen and broaden their thinking skills,” we will increasingly need to refine our teaching and assessment methods. I look forward to working with students to explore ways to implement these methods that lead to effective learning.